(1)
Department of Family Medicine, University of California, Riverside, Riverside, CA, USA
Key Points
1.
Complications of labor include prolonged transition from latent- to active-phase labor, failure of cervical dilation, and failure to descend.
2.
Diagnosis of an abnormality of labor requires a firm understanding of the normal progress of labor.
3.
Each complication of labor requires individual assessment and management.
Background
Most pregnancies will proceed with a minimum of abnormality and delivery will occur without significant complications. All deliveries have the potential for complications; providers should be aware of and prepared for the potential complications associated with delivery of the infant.
Complications of Labor
Labor is defined as uterine contractions resulting in progressive cervical dilation, effacement, and eventual delivery of the infant. The normal course of labor is reviewed in Chap. 19. In general the progression of labor depends on three identifiable factors: adequate uterine contraction (both frequency and force), fetal size and position, and adequate pelvic anatomy to allow descent. Routine labor management includes sequential assessment of labor progress via manual examination of the cervix and presenting fetal body part. Although labor is predictable and progressive in most patients, under some circumstances the normal progression is disturbed. These may include a delay in the transition from latent- to active-phase labor, failure of cervical dilation to occur, and occurrence of dilation without fetal descent.
Prolonged Latent-Phase Labor
Latent-phase or early labor is the period marked by contractions and initial cervical dilation. The contractions are generally frequent and less strong than those of active labor and the progress of cervical dilation may be variable. Although average latent-phase labor lasts between 5 and 8 h, there is considerable variability. Often, the management of latent-phase labor occurs outside the medical facility. Ideally, patients without obstetrical complications or medical risk factors would arrive at the hospital in active labor, having self-managed the latent phase of labor.
Under some circumstances, however, patients will present for management while in latent-phase labor. When the latent phase of labor has continued significantly beyond the expected duration (>20 h in nulliparous patients and >14 h in multiparous patients), management decisions must be made. Most patients with prolonged latent-phase labor will progress to active labor and subsequent vaginal delivery.
History
Management begins with a review of the patient’s history. Review of the gestational age, prenatal course, and prior obstetrical history, if any, should be performed. Although most instances of prolonged latent-phase labor are idiopathic, use of sedation and alcohol and prior episodes of prolonged labor may all be associated with a prolonged latent phase.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
